Imagine a cancer center constructed without materials that contain known human carcinogens, or a hospital with healing gardens and beautiful views. These are among the more than 160 strategies that define a new age of “high-performance healing environments,” according to the Green Guide for Health Care, a new tool being used to guide development of some of the largest health care construction projects in Boston.
The GGHC is a voluntary, self-certifying building system modeled with permission after the US Green Building Council’s LEED rating system. But GGHC is tailored to the health care sector in two important ways: it addresses the particular requirements of health care facilities, and it focuses on the health benefits of green strategies. “As the first green building system based on health values, the Green Guide provides the framework, so to speak, for the health care industry to fulfill its promise to ‘first, do no harm,’” says Robin Guenther, an award-winning health care architect and member of the GGHC Steering Committee.
The idea of building hospitals that are healthy for people and the environment is catching on. More than 6,000 people have registered on the GGHC web site, and there are 64 active pilot projects by 58 health organizations in 22 states, two provinces, plus Poland, China and Malaysia.
Here in Boston, several major health care institutions are incorporating green building strategies from the GGHC — including the $1.3 billion Children’s Hospital-Boston project, the $350 million Brigham and Women’s Hospital expansion, Dana Farber Cancer Institute, Beverly Hospital and Spalding Rehabilitation Hospital.
Leaders of these institutions were present in October 2005 at the Design for Health Summit, an intensive two-day discussion of the opportunities and challenges of implementing sustainable design in the Massachusetts health care sector. A joint venture of the Rocky Mountain Institute and Health Care Without Harm, the Summit resulted in the Boston-area’s top hospitals pledging to put the region’s health care sector at the forefront of the growing green building movement.
Boston Mayor Thomas Menino gave the keynote speech, pledging the city’s support to the effort. “Never before have so many decision makers from Boston’s leading health care institutions gathered to explore ways of incorporating green technology into their buildings. It’s a concept whose time has come. The future of development lies in high performance technology — what’s known as green building,” Menino said. “It’s only fitting that Boston’s healthcare industry should embrace green technology. It’s good for public health. It’s good for the environment. It’s good for your bottom line. And it’s good for the overall economy.”
Since the Summit, the Boston Society for Architects has formed a heath care committee that is offering sessions on sustainable building strategies, and a series of “lunch and learn” workshops have focused on topics such as “Sustainability 101,” “Navigating through the Green Guide,” and “Building a Green Team.” Several Boston-area hospitals are also now developing cost-effective green strategies for the construction and operation of huge new facilities. Strategies under consideration include using innovative technologies to reduce energy and water use, choosing safer materials that do not leach hazardous chemicals, and incorporating healing design elements such as natural daylight and views.
The healing power of design elements such as windows in patient rooms has been known for decades. A 1984 study published in Science Journal found that patients with views of nature went home three-quarters of a day sooner, had a $500 lower cost per case, used fewer heavy medications and exhibited better emotional well being. In addition to improving patient outcomes, studies show that good health care facility design also helps improve staff recruitment and retention, and worker health and productivity.
Green strategies can also bring increased philanthropic opportunities – as Mass General Hospital found recently when it received donations from a non-profit trust, and from individuals, for the new rooftop healing garden at the Yawkey Center for Outpatient Care.Unveiled in October 2005, the new indoor/outdoor healing garden sits atop the roof on the eighth floor, adjacent to the Oncology Department. The garden overlooks the Charles River and has one of the most spectacular views in Boston, along with a reflecting pool, trees and grass, granite pathways and natural teak furniture. It is this kind of space that is emblematic of the natural world’s restorative powers of healing, reflection and tranquility – a space devoid of disturbances that reduces stress and anxiety, and will increase patient satisfaction.
As more hospitals engage in green building, a consensus is growing that building green doesn’t have to mean increasing cost. In fact, financial benefits over the life of the building can well exceed the initial investment of green strategies. In one example, a hospital system found that using rubber flooring instead of vinyl sheet tile had an initial higher cost, but the cost was offset by the savings – not to mention health benefits – of not having to wax and strip the VCT flooring with harsh chemicals for routine maintenance.
Planning green from the ground up, using an integrated approach that draws together architects, designers and engineers in the initial planning stages, is an important strategy for devising creative cost-neutral or cost-saving approaches. As Mayor Menino noted in his keynote, “The best way to ‘go green’ is to integrate your design and engineering from the very start – that’s where the real savings are, and that’s the smart way to do it. But even small changes can make a big difference. Incorporating even just a few elements of green technology can improve the health of your patients and employees. For example, using paint and carpets made from non-toxic materials can reduce breathing problems for people with asthma.”
Menino also noted that the sheer size of Boston’s health care industry – employing over 58,000 people and accounting for an estimated five million square feet of building space – gives the industry the power to drive markets toward greener, more sustainable building practices and materials. “As leaders in the healthcare industry, you have the purchasing power to change the supply-side and demand of green materials,” he said.
As one example of health care’s power to move markets, Kaiser Permanente, the largest no-profit health care system in the U.S., pledged in 1999 to eliminate phthalates – a chemical that causes birth defects in animal studies – from hospital supplies. A front-page article in the Wall Street Journal noted that, “Demand from the HMO has helped drive development of medical gloves that don’t contain phthalates, as well as non-PVC carpeting and a new line of phthalate-free plastic handrails, corner guards and wall coverings.”
Kaiser Permanente’s activity was driven by the health system’s commitment to the Precautionary Principle – the idea that when there is credible evidence that a material may result in environmental harm, it is prudent to choose safer alternatives. At the heart of this approach is the understanding that healing the environment will improve health and reduce disease – undoubtedly a win, win for the health care industry. As more hospitals embrace green design and materials, they are paving the way toward a healthier future.
Bill Ravanesi, MPH, is Boston Campaign Director for Health Care Without Harm, where his work centers on pollution prevention and green building in the health care sector. Prior to his healthcare work, he was the founder and president of the Center for Visual Arts in the Public Interest, Inc. in Boston. He has received National Endowment for the Arts grants and Ford Foundation Fellowships. Bill has a long-standing commitmentto community service and activism.
